14-0002 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
I47
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
14-00000002
Property Address:
53800 AVENIDA RAMIREZ
APN:
774-162-025-22 -000000-
Application description:
WALL/FENCE,
Property Zoning:
COVE RESIDENTIAL
Application valuation:
3100
Applicant: Architect or Engineer:.
---------------------------------------------------
`" LICENSED.CONTRACTOR'S-DECLARATION '
I hereby affirm -under,' penalty.of_perjury that I•am licensed undei,prowsions of Chapter 9 fcommencing with -
Section 7000) of Divi 3 of1...the Business and Professionals Code;;and,my License is in full force and effect.
license Class: License No '
Date: Contractor: =
OWNER -BUILDER DECLARATION
I herebyaffirm under penalty of perjury that I. am,exempt,from the Contractor's State License law�for the
"following reason (Sea -70411.5, Business and Professions Code:Any city or county that requiresa,permit to_.
construct, alter, improve, demolish, or repair'any structure, prior to its issuance, also requires the applicant for the
permit to file,a signed.statementtnat he;or she is license pursuant to the provisions of. the Contractors State
License Law (Chapter.9-(commencing with5ection 70001 ofDivjsion 3 of. the and Profession's Code) or
.. that he-or.she-is exempt therefrom and: the ;basisfor the allegedexemption. Any violation of. Section 7031.:5 by
-any, applicant .fora permit subjects the applicant to a:civil penalty'of not more than five hundred dollars (S.500)'r: -
1, as owner of,ihe property, or my employees with wages as their sole compensation; will do the work, and
f/—v,the structureIis not iniended or.offered for'sale (Sec. 7044; Business and Professions Code:, The
Contractors'• State License Law does,no
he -t appiy.to an:owner of property who builds or improves thereon,
and'who does the Work himself or rself.throughi his or her'own-employees; provided that.the
improvements are not intended,or.,offered.for sales. If, however, the building or improvement is sold within
one year of completion, the owner builder will' have the burden' of proving that he or she did not build or -
improve for: tiie purpose of=sale.).
I,as; owner.of the.property, am exclusively. contracting with licensed: contractors to construct the project (Sec.
Y" "7044, Business and ProfessionsCode The Contractors' State License Law, does!not.applyto an owner of
-, .- t property -who builds orimproves'tiSereon; and"who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
0401L, am exempt under Sec. , B.&P.C. for this reason
CONSTRUCTION LEN NG AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
JEFF JOHNSON
53800-AVENIDA RAMIREZ
LA.QUINTA, CA 92253
(760)360-7858
Contractor:
Owner.
VOICE (760) 777-70.12
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/02/14
0
WORKER'S COMPENSATION DECLARATION
-I hereby affirm under: penalty; of perjury one,of :the following declarations:
I have and will maintain a•certificate of,consentto self insure foi:workers compensation, as provided
for by Section 3700 of:the Labor Cede; for•the"performance of ,the work.for•which. this permit is -
-issued'-
._ .. -
I have and will maintain workers' compensation insurance, A required by Section 3700 of the Labor
Code, for the performance of the-work-forwhich'ihis:perrnit`is issued. "My. workers' compensation.
insurance carrier:and.policy nuinbe}'are: '
Carrier - - - - - - - -Policy Number _
-' 'I'certify that, in the performance of the woikfor which this permit is issued, I,shall not employ any -
• C( //.person in any manner so as to become subject to the workers compensation laws of California,
v and agree that rf,l should become subject to the workers Compensation:provisions of Section
3700 of the�Labor`Code, l"shall forthwi comply with those'proviswns""
":WARNING: FAILURE TO SECUR WORK RS' COMPENSATION COVERAGE ISUNLAWFUL, -AIVD SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL.FINES UP TO ONE .HUNDRED -THOUSAND
DOLLARS Is 100,o00)' IN.ADDITION TO THE COST OF COMPENSATION, DAMAAGES`A'S PROVIDED FOR IN.
-. SECTION 3706 OFTHE'LABOR CODE, INTEREST,AND, ATTORNEY'S FEES. - -
• -• APPLICANT ACKNOWLEDGEMENT -
IMPORTANT Application,is hereby;made to7the Director of Building an6 Safety for a permit subject to the,
' conditions and restrictions set forth on this application. '
I . Each person upon whose behalf this application is made, each person at whose request andfor
whose benefit work is performed under or pursuant to any permit issued as aresult of this. application,
the owner,' and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents -and employees for any act or omission related to the work being
performed under or following issuance of this permit. -
2. Any permit issued as.a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation. -
I certify that I have read this application and state that the above information is correct. I, agree to comply with all
city and county.ordinances and state laws relating to building. construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspec ion purposes.
Dat /i��p/ � 1
'---`-`_ Signature (Applicant or Agent). /
V
LQPERMIT
Application Number . . . . .
14-00000002
Permit . . . WALL/FENCE
PERMIT 2013
Additional desc .
Permit Fee 7.5.79
P1an.Check Fee
.00
Issue Date . . .
Valuation . . .
. 3100
Expiration Date 7/01/14
Qty Unit Charge Per
Extension
1.00 47.1900 LS MISC-WALL,
FIRST 100 LF
47.19
2.00 14.3000 EA .. MISC
WALL, ADDL 50 LF
28.60
Special Notes and Comments.
183 -LF . OF!-6'AT NORTH AND
EAST
PROPERTY LINER. 201.3 CALIFORNIA
-BUILDING_
-CODES.
Other Fees.-
BLDG STDS ADMIN (SB1473)
• 1.00 - -
PLAN CHECK; WALLS
60.06
Fee .summary Charged
Paid: Credited'
Due..
Permit. Fee Total 75.79
.00 .00
75.79
P1ari.Che6kt.Tota1 :-_00.
..00 00'
00
Other'Fee.Total 6.1.06-:
.'0.0 00=-
61.,0:6
Grand, Total T'36'. 85:
00 .0.0
136 -'85
Bin #
Submittal
City of.- Quihta
Building tat Safety Division
P.O.-Box 1504,'78495 Calle Tampico
La Quints; CA. 922513- (760) 777-70.12 .
Building Permit: APPlication ands Tracking :Sheet
Permit #
l (�
Project Address: S" 3 3 UO
,Q r, �. o� y`� fe ie
Owner's Name:. �j�jL . j Off•✓S
A. P. Number:
Address: er-3 $00 fGv,i✓ �)�a'^ #�� Z—
Legal Description:
City, ST, Zip: �. ..✓ T
Contractor:
Telephone:
::;••;.•a:�-;�:::;};:>..;:;;>.}>
Address:
Reviewed; ready for corrections
Project'Description:
City, ST, Zip:
Telephone:
-Called Contact Person ` .
State Lic. # :
Plan Check Balance
City Lic. #.-
Arch., Engr., Designer.
Address:
Construction
City., ST,. Zip:
Flood plain plan
Telephone:
<"::>»>;:;<::;<:n<:;::>:<: ..;,::;;•.;.<.;:::
Construction Type: Occupancy:
`�Projecf type (circle one): New Add'n Alter Repair Demo
State Vic. #:
Name of Contact Person:
Grading plan
:`Sq. Ft.:
#, Stories:
# Units:
Telephone # of Contact Person:
Electrical
,. 'Estimated Value of.Proj 3
APPLICANT: DO NOTs.IA/RITF' RFI `OW .THIS, I INF'
#
Submittal
Req'd
Rec'd
' TRA"G
PERMIT FEES
Plan Sets
Plan Check submitted'
Item
Amount
Structural Cates.
Reviewed; ready for corrections
Plan Check Deposit
Truss Calcs.
-Called Contact Person ` .
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for correctionsrissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
`Total Permit.Fees
a
/ I
.., P.O.:Box 1504
LA QUINTA, .CALIFOR'N'IA 92247-1504• BUILDING &'SAFETY DEPARTMENT
78-495 CA[ LE TAMPICO: "' ' . , (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
PROPERTY OWNER'S PACKAGE
Disclosures &Forms for 0v�%aer-Bailders Applying for Coistructioa Permits
�1.R��NTI' NOTICE TQ gRQPE�Ti� OWNER..,
DearPmperty Owner
co
An:. application. -:for a building permit has'.,been nutted in yoetr 'name Iisttag.yourself as the builder of the .property
imprdv ements specified at`� o c> :4 ✓;'sw e
We are providing you'with an Owner -Bu lderAclmoMedga ent and InformationVeiiftcationTo' "n'to make }you awave:of your
respowibilities and possible i* you may, mcur'by having 4* tis issued,m your;Haase�as the
Owneir. Builder. Wilwitl''not issues bpfldiug:permit until you have>'read;:initialed yot r`a�derstanding of csach'provlsion, .
signed, and returned this form to us at our official address indicated: An agent, of tip ovvnci cannot execute'this notice
unless you, the property owner, obtain the prior approval of the permitting;authority.
����'A:•�i1�ir7�Ti�'R'�1FA�'.��.'i!.�'�:Y►Tilt:n+ti�+r�.��a.�.r»i�'ii�s�ts±�ia�c��siiit-•. -.. -. .
1 - I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
building permit that erroneously implies that the property owner is providing his or her' own labor'and aiaferial personally. I, as
an Owner -Builder, may be held liable and subject to serious finaacial'risk for any injuries sustained by an unlicensed person
and his or her employees while working :oh- my property.-, bly homeowner's -insurance may. not. provide coverage for those
injuries- I am willfully act as an Owner -Builder and'am:aware of the limits of myinsurance.coverage for injuries to workers
:on my. property-
�9' 2. I understand building permits are not required to be, signed by property owners unless they are responsible for the
construction and are not.hrring a..censed Contractor to assume this,responstbility..
3. I understand as an."Owner Buildei" I,am the:responsrble party of record.on the permit I understand that I may, protect
myself frons potential financial risk by hiring, a licensed Contractorand`havffig the permit filed in his or her name instead of my
own.
S?- 4. I understand Contractors are required by law to be licensed,and bonded in California and to list their license numbers on
permits and contracts. '
5. I understand if I employ -or otherwise engage any persons, other thanCalifornia licensed Contractors, and the total value
of my construction is at least five hundred dollars ($500); including labor and materials, I :may be -considered an "employer"
under state and federal law-
94/"6- I, understand if I am considered an,`.`employer" under state, and federal law,.I:must register with the state and federal
government, ,withhold payroll ,taxesprovide workeis' compensation disability, insurance, and contribute to unemployment
compensation for each "employee."' I also' understand my 'failure: to abide by these laws may subject me to serious financial
risk
7-, 7. I understand under California Contractors' StateLicense Law, an Owner -Builder who builds single-family residential
structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed
subcontractors and the. number of structures 'does not exceed four within any calendar year,' or all of the work is performed
under contract with a licensed general building;Contractor.
A
1
X8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be he'd liable, for any
financial or personal_ injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
LZ
9. I understand I may obtain more information regarding my obligations as an "employee" from the Interud IR®venue
Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-
8000-3221-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
V 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
party legally and financially responsible . for proposed construction activity at the following address:
Q"1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner=Builders as well as employers.
I agree to notify the issuer of this form immediately of any additions; deletions, or changes to any of the information i
have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone who _does not bave a license, the contractors' State License Board may be unable to --wist-you WA my finanew loss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in�civil court. It is also
important for you to: understand that if an unlicensed Contractor or employee of that individual or firm is injured while worting
on your property; you may be held. lianle for damages. If you obtain a permit as Owner -Builder and wish to hire Contraetars,
you wdl be responsible for. verifying whether or not those Contractors are properly licensed and the status of tkir woeicers'
compensation insurance coverage.
Before a building perndt can be issued, this form must be completed and signed by the property owner a" returned to
the agency responsible for issuing. &e. permit Note. A copy of the property owner's fiver's ikensy form notar*sadrn; or
other verification acceptable to the agency is required to be presented when the permit is issreed to verify the property
owner's signature.
Signature of property owner Date:
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand. is my personal responsibility, I hereby authorize
-the following persons) to act as my agent(s) to apply for, sign, and file�the documents necessary to obtain an Owner -Builder
Permit for my project
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above
information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification
acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature.
Property Owner's Signature: Date:
Bin #
City of La Quin to
Building &r Safety Division
P.O. Box 1504;.78 `49S.Calle Tampico
La-Quinta,,CA 92253 - (760) 777-7012
Building Permit Application-ind Tracking Sheet
Permit #
Project Address:
Own`et's Name:
A. P. Number:
Address:
Legal Description:
. City;"ST, Zip:,
Contractor:
Telephone:
. r.:.
Address:
Project Description:
City, ST, Zip:
Telephone:
State Lic. # :
City Lic. #;
Arch., Engr., Designer.
Address:
City., ST, Zip: r
Telephone:.
p
`x`' < a>::<.:.<:<::;<r,;;,.<>.;:-;:,:•<'>
;;;>•..:»:;:>:::<:,:<;vsszzi!«„s:�:.<.
r tiu ti n T c
Cons c io ype: u O c.pancy:
type.(circle one): ` New Add'n _ Alter Repair Demo
State Lic. #:
.....;,; ...°project
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated. Value of Project:
APPLICANT: DO NOT 1NRITE:BELQW THIS.LINE
#.
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
.-Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
`tad Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up`
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
' ',Reyiew, ready for correctibnsMsue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr .
Date of permit issue
School Fees
t
.
Total'Permit Fees
l
o �e
d ( -r /.,-c _(!J
CITY OF LA QUIN A
BUILDING & SAFETY DEPT.
APPROVED
DATE J 12-/(4BY